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Objective: Traditional Ivor Lewis esophagectomy is associated with significant morbidity and mortality rates ranging from 2 to 10%. Robotics has been applied to minimally invasive esophagectomy in varying degrees with promising results. However, total robotic Ivor Lewis remains the ultimate goal. We report our experience in robotic esophagectomy which began as a hybrid procedure and evolved to a completely robotic procedure with intrathoracic anastomosis.
Methods: We performed a retrospective analysis of all patients who underwent robotic assisted esophagectomy between January 2004 and July 2013. Patients were divided into two cohorts: 1) Initial technique involved a laparotomy for the abdominal portion, followed by robotic thoracic portion with stapled anastomosis; 2) Recent technique with completely robotic procedure with intrathoracic robotic hand-sewn anastomosis. Basic demographic information was obtained along with operative data, complications, and mortality.
Results: Robotic assisted esophagectomy was performed 60 patients. 50 had a robotic hybrid procedure (laparotomy and robotic thoracic surgery, with stapled anastomosis) (42 men, 62+/-10 years; 8 women, 52+/-8 years). 10 had completely robotic esophagectomy with intrathoracic hand sewn anastomosis (8 men, 61+/-9.2 years; 2 women, 63+/-15 years). Preoperatively, esophageal cancer was present in 38 patients, achalasia in 2, and high grade dysplasia in 8. Avg operating time for the hybrid procedure was 589+/-90 min, and for the completely robotic procedure was 676+/-51 min. Median hospitalization was 11 days in both groups. Pathology showed adenocarcinoma in 72%, Barrett’s esophagus in 5%, squamous cell carcinoma in 5%, and no residual tumor in 15%. The most common complications were atrial fibrillation (6), and anastomotic stricture (7). There were 2 anastomotic leaks (1 hand sewn, 1 stapled anastomosis). 30 day mortality was 4/60 (6.7%).
Conclusion: Ivor Lewis esophagectomy for esophageal cancer can be performed safely with robotic assistance with mortality rates similar to recent literature. Intrathoracic anastomotic technique is continuing to evolve and requires further data to assess outcomes.